Healthcare Provider Details

I. General information

NPI: 1922060656
Provider Name (Legal Business Name): CEDAREDGE DOCTORS OFFICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 S GRAND MESA DR
CEDAREDGE CO
81413-3822
US

IV. Provider business mailing address

255 S GRAND MESA DR
CEDAREDGE CO
81413-3822
US

V. Phone/Fax

Practice location:
  • Phone: 970-399-2611
  • Fax: 970-856-4114
Mailing address:
  • Phone: 970-399-2611
  • Fax: 970-399-2859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN COHEE
Title or Position: CEO
Credential:
Phone: 970-874-2285